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ensuring that women are knowledgeable about and can access existing resources, and thatproviders and programs have the capacity to meet the demands for breast cancer screening andtreatment of low-income residents who require no-cost care.Many women living in the Southwest Washington region struggle with lack of information aboutbreast health resources, transportation and poverty. Women’s health care is very fragmented andtypically involves sending a woman to several providers when she is diagnosed with breastcancer. Communication can be difficult and women may get lost in the system.Qualitative Data ReviewThe Affiliate gathered input from key stakeholders whose connection to residents of targetedgeographic areas and to racial and ethnic communities and their issues would be helpful to thecommunity profile process. Key informant interviews and/or focus groups were conducted to getperspectives from those living and working in the target areas and populations. Participantsincluded community leaders, employees of county health departments, representatives from localhospitals, WBCCHP Prime Contractors and subcontractors, breast cancer survivors and healthcare providers.Financial barriers and lack of health care insurance are the most commonly reported reasons whywomen of color don’t get screened. This is followed by the lack of awareness or prioritization ofbreast health or preventive health care practices in general. Myths about breast cancer andmammograms, as well as cultural taboos, fears and modesty issues were all commonly cited asbarriers to screening among women of color.There are many concerns among racial and ethnic minorities about trust, and the intentions of thehealthcare system. Based on their past history, this is especially true for African American andNative American women who may fear experimentation or doubt the intention of healthcareproviders to care for people of color. Undocumented Hispanic women often fear theconsequences of entering a government-supported program, doubt the actual anonymity of careand may find questions from providers to be intrusive and alarming.ConclusionsBased on detailed analyses of the breast cancer statistics, demographic information, healthsystem resources and qualitative data, we identified areas of need:African American, Hispanic, American Indian/Alaska Native, Vietnamese, PacificIslander and Asian Indian women need early detection services and support duringtreatment.Lewis, Pacific, Grays Harbor and Mason counties in Southwest Washington continue toneed increased access to quality and convenient breast cancer treatment as well as earlydetection services.King, Pierce and Snohomish counties have the greatest burden of women in need ofservice, particularly women of color; women living in these counties need moreinformation about available resources, as well as increased capacity for screening, patientnavigation and treatment support.7

A common theme heard among all counties and populations was the need to increaseawareness about breast health and about available resources and the need to address gapsin transportation, particularly in rural areas, and interpretation services to addresslanguage barriers of racial and ethnic minority women.However, the current economic climate has resulted in tremendous increase in demand for freeor low cost breast health services. The Affiliate does not have adequate resources to meet thisdemand, but is committed to working with our partners to preserve and protect current servicesand will continue our commitment to increase funding to invest in proven effective life-savingstrategies.Action PlanGoal: Increase breast cancer screening, patient navigation and treatment support servicesoffered in Grays Harbor, Lewis, Pacific and Mason counties, particularly for low-income,Hispanic and American Indian/Alaska Native women.Objective 1 – By March 2014, increase investments in effective screening, patient navigationand treatment support services and cultivate new applicants to the Affiliate’s grant programsthat meet our target communities and priority service areas.Objective 2 – Each grant period, increase by 5% the number of women enrolled and screenedthrough WBCCHP and other partners providing low/no-cost screening, especially amongHispanic and American Indian/Alaska Native women.Objective 3 – By March 2014, work with local partners to develop new and expand currentawareness campaigns (using traditional and social media, Worship in Pink, HispanicInitiative, etc.) that target low-income, Hispanic and American Indian/Alaska Native womenin these counties.Goal: Increase breast cancer awareness, screening and patient navigation in King,Snohomish and Pierce counties for low-income, African American, Hispanic, AmericanIndian/Alaska Native, Vietnamese, Pacific Islander and Asian Indian women.Objective 1 – By March 2014, increase investments in effective education, screening andpatient navigation services and cultivate new applicants to the Affiliate’s grant programs thatmeet our target (current and new) communities and priority services.Objective 2 – By March 2014, expand Worship in Pink campaign to include faith-basedorganizations beyond the African American community.Objective 3 – By March 2014, increase the number of African American, Hispanic,American Indian/Alaska Native, Vietnamese, Pacific Islander and Asian Indian women whoare enrolled in WBCCHP by 5% each grant period.8

Objective 4 – By March 2014, work with local partners to develop new and expand currentawareness campaigns (using traditional and social media, Worship in Pink, HispanicInitiative, etc.) that target low-income, African American, Hispanic, American Indian/AlaskaNative, Vietnamese, Pacific Islander and Asian Indian women in these counties.Goal: Improve access to breast health and treatment services throughout our Service areathrough strategic alliances and change in public policy.Objective 1 – By March 2014, work with National Komen, regional and local partners toadvocate for increased federal and state funding for WBCCHP.Objective 2 – By March 2014, work with Affiliate lobbyist to advocate for and prevent cutsto existing transportation programs and collaborate with American Cancer Society to expandits volunteer transportation program.Objective 3 – By March 2014, work with Affiliate lobbyist and other partners to preserveand/or increase funding for medical interpretation services.Objective 4 – By March 2014, develop strong alliances with existing and new partners thatcan help to move the Komen mission forward through Health Reform implementation.9

IntroductionPurpose of Community Profile ReportThe purpose of this updated report is to assess the extent and prevalence of breast cancer in theService Area. The writers of this report examined statistics, services and community perspectivesto identify disparities, gaps in service and barriers to care that prevent women from detectingbreast cancer early. This report will be used to set Affiliate priorities, goals and objectives in itsstrategic planning, grant making and educational efforts to ensure that we are meeting ourpromise to save and improve lives.Affiliate HistoryNancy G. Brinker promised her dying sister, Susan G. Komen, she would do everything in herpower to end breast cancer forever. In 1982, that promise became Susan G. Komen for the Cure,which is the world’s largest breast cancer organization and the largest source of nonprofit fundsdedicated to the fight against breast cancer with more than 1.3 billion invested to date.The Komen Puget Sound Affiliate in Washington (the Affiliate) was founded in 1993 to forwardthe mission of the National organization – to save lives and end breast cancer forever byempowering people, ensuring quality of care for all and energizing science to find the cures.Since inception, the Affiliate has invested nearly 23 million in local nonprofit, tribal andgovernment agencies that provide breast health/breast cancer services to medically underservedresidents of our sixteen county service area.Affiliate Organizational StructureThe Affiliate is led by a 15-member board of directors and 13 employees. The Affiliate alsorelies on hundreds of volunteers to fulfill its scope of work.10

Description of Service AreaThe Affiliate serves 16 counties in Western Washington that includes Whatcom, Skagit, SanJuan, Island, Snohomish, King, Kitsap, Clallam, Jefferson, Mason, Pierce, Thurston, Lewis,Grays Harbor, Pacific and Wahkiakum Counties (the Service Area). The Service Area containsmajor metropolitan cities, rural towns, remote coastal communities and islands that can only beaccessed by boat or plane. See map below.For the purposes of this report, the Service Area is divided into four regions:Greater Metropolitan AreaKing County is the most populated county in Washington. Its largest city is Seattle, with apopulation of more than 600,000. Other primary population centers located on the I-5 or I405 corridor include Bellevue, Redmond, Kirkland, Renton, Kent and Federal Way. Theeastern most part of the county is more rural and less densely populated.Kitsap County is located on the Kitsap Peninsula in the center of the Puget Sound Basin.The population is concentrated within seven major communities – Bremerton, Port Orchard,Poulsbo, Hansville, Silverdale, Kingston and Bainbridge Island. Bremerton is the largest citywith a population of 37,700 but due to the presence of the military, the population tends to betransient. In fact, nearly 70 percent of the county is unincorporated. The northern part of thecounty includes two tribal areas – Suqaumish and S’Klallam.11

Pierce County is located in the southern Puget Sound area and contains a large metropolitanarea (Tacoma), rural farmland, national park and forest area (Mt. Rainier) and two militarybases. The majority of people are concentrated in Tacoma and along the I-5 corridor. Thelargest employer in Pierce County is the Joint Base Lewis McChord. There are a number oftribal areas in Pierce County, including the Puyallup and Nisqually reservations.Snohomish County is located in the north Puget Sound area. The largest city is Everett,which has 24 percent of the entire county’s population. Other major cities in the westernregion include Lynnwood, Bothell, Marysville and Edmonds. The eastern part of the countyis primarily rural and has limited public transportation.Olympic PeninsulaClallam County is west of Seattle and bordered by the Pacific Ocean, the Strait of Juan deFuca and Jefferson County. Major population centers with health services, east to west alongState Route 101, are Sequim, Port Angeles and Forks. Most of the southern part of ClallamCounty is part of national or state forestland and therefore is not inhabited.Jefferson County is located on the Olympic Peninsula, west of Seattle. The largest town isPort Townsend, which is located in the extreme northeast corner. Other towns includeBrinnon and Quilcene in the southeast part of the county. The entire middle of the county iscomposed of Olympic National Park. A small, remote strip of Jefferson County lies along thePacific Ocean and includes Kalalock, Queets and Clearwater.Northwestern CountiesIsland County is comprised of Whidbey Island and Camano Island. While Whidbey Islandis a true island, Camano is physically connected to Snohomish County. This physicalconnection has resulted in a stronger linkage between Camano and Snohomish and Skagitcounties for purposes of seeking services. The majority of Whidbey Island is rural. There arethree population centers - Oak Harbor in the north, Coupeville on central Whidbey Island andClinton in the south. Oak Harbor is home to the Whidbey Island Naval Air Station.San Juan County is located in the northwest corner of the state and comprised of multiplesmall islands. Population and services are principally located on one of three larger islands,San Juan, Lopez and Orcas.Skagit County is located in northwestern Washington and bordered by Whatcom County tothe north, Snohomish County to the south, the Puget Sound to the west and Chelan andOkanogan Counties to the east. Mount Vernon and Anacortes are the largest cities.Whatcom County is located on the northern boundary of Washington State with BritishColumbia, Canada to the north. The county is surrounded by Puget Sound to the west, SkagitCounty to the south and Okanogan County to the east. Most of the population in WhatcomCounty is concentrated along the I-5 corridor. The major population center is Bellingham,which accounts for 59 percent of the county population. Bellingham is also the location of12

Western Washington University. The eastern and northern portions of Whatcom County arerural.Southwestern CountiesGrays Harbor County is situated on the coast, bordering Mason and Thurston counties. Thecounty is largely rural. The largest incorporated cities are Aberdeen and Hoquiam. Othersmaller towns lie along the main road to Olympia and along the coast.Lewis County is situated at the southern end of the Puget Sound region, just below ThurstonCounty. It has the sixth largest land area of all counties in the state, and is predominantlyrural. Centralia is the largest city in the county.Mason County lies on the southern end of the Olympic Peninsula, south of the Hood Canal.A large portion of Mason County is part of Olympic National Forest and uninhabited.Shelton is the largest town in the county and accounts for almost 65 percent of the county’spopulation. The county is home to the Skokomish and Squaxin Island Indian Reservations.Pacific County is on the west coast of Washington. It is primarily rural and composed ofsmall towns, most of which hug the coastline. Most of the population lives in unincorporatedareas. The largest town is Raymond.Thurston County is the fifth most populous county in the Affiliate’s Service Area and lies atthe southern tip of Puget Sound. The population of residents is concentrated in Olympia andLacey, which account for nearly 82 percent of the county’s population.Wahkiakum County is located in the southwest corner of Washington, along the ColumbiaRiver. It is the least populated county in the Affiliate’s Service Area with less than 4,000people. Due to its rural nature, services are limited and the nearest access requires extensivetravel.13

Breast Cancer Impact in Affiliate Service AreaMethodologyThe majority of data used in the demographic section of the Community Profile was obtainedthrough the Thomson Reuters 2009 package: a Komen National commissioned custom moduleof estimated demographic data for the Service Area.The Affiliate relied on local and national sources for our region’s breast cancer sta

Ms. Komen's younger sister, Nancy Goodman Brinker, founded the foundation in 1982. The Komen Puget Sound Affiliate was founded in 1993 to forward the mission of our . Financial barriers and lack of health care insurance are the most commonly reported reasons why